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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Tusk "r)t'l il <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> VI 13 �$� \Gt.0 �YRtYt.t. t VL-I .031 b Variance Restriction; ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS n <br /> (p oVt-if 17,VS' GjBut c-kI S\^w ° UVI i I.Cu'"`, ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Cl Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL .°1+ ,_36�, _0�5j .1j ix _\ v frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: g H 7T'u SE TION: <br /> � '/a: '/a'/a: ❑ Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> (On I) Lox:,Si66 Ly-v Sc N c 3 S ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> L i ' Sco \,,1^W (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> SW& \ Z 4- 1 to LI zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER SEPTIC (new/existing) <br /> HEIGHT IN FEET: 1 2 P NUMBER OF STORIES:(Not including basement) Li WetiandlF atN <br /> c� Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: ,3 � y.` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ,'^ -4- <br /> BASEMENT: 1ST FLOOR: " El perms <br /> j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: I n„CI__ ❑ filling/access) <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 6 6 v and available options. <br /> (Please round to nearest dollar) S 5, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Cl Yes ' No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes 4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i ♦ -i <br /> 545-112(4ro8) <br />